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平价医疗法案实施前后 Medicare 人群中筛查性乳房 X 光检查的应用。

Utilization of Screening Mammograms in the Medicare Population Before and After the Affordable Care Act Implementation.

机构信息

University of Maryland School of Pharmacy, Baltimore, USA.

Columbia University Mailman School of Public Health, New York, NY, USA.

出版信息

J Aging Health. 2020 Jan-Feb;32(1):25-32. doi: 10.1177/0898264318802047. Epub 2018 Sep 22.

Abstract

This study examined screening mammograms in women aged 65 to 74 years and 75+ years before and after the Affordable Care Act (ACA) implementation. This repeated cross-sectional study of community-dwelling women age 65+ years without a history of breast cancer or mastectomy utilized the Medicare Current Beneficiary Survey and Medicare fee-for-service claims data from 2001 to 2013. We used covariate-adjusted logistic regression with generalized estimating equations, stratified by age group. The adjusted odds of screening mammograms in women aged 65-74 ( = 742) and 75+ years ( = 681) were lower in 2013 (odds ratio [OR]: 0.75, 95% confidence interval [CI]: [0.67, 0.83]; OR: 0.67, 95% CI: [0.60, 0.75], respectively) than the odds of screening mammograms in 2001. Annual screening mammograms decreased in women aged 65 to 74 years and 75+ years, despite increased access from the ACA implementation. Future research as to why women are no longer receiving screening mammograms, such as changes in physician specialty guidelines, is warranted.

摘要

本研究调查了平价医疗法案(ACA)实施前后,65 至 74 岁和 75 岁以上女性的筛查性乳房 X 光检查情况。这是一项针对无乳腺癌或乳房切除术病史的 65 岁以上社区居住女性的重复横断面研究,利用了 2001 年至 2013 年的医疗保险当前受益人和医疗保险收费服务索赔数据。我们使用了广义估计方程的协变量调整逻辑回归,按年龄组分层。在 2013 年,65-74 岁(n=742)和 75 岁及以上(n=681)女性接受筛查性乳房 X 光检查的调整后几率(OR)分别低于 2001 年(OR:0.75,95%置信区间[CI]:[0.67,0.83];OR:0.67,95%CI:[0.60,0.75])。尽管 ACA 的实施增加了获得筛查性乳房 X 光检查的机会,但 65 岁至 74 岁和 75 岁及以上女性的年度筛查性乳房 X 光检查次数减少。需要进一步研究为什么女性不再接受筛查性乳房 X 光检查,例如医生专业指南的变化。

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本文引用的文献

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